Provider Demographics
NPI:1366451056
Name:DUNWELL, BRUCE STEPHEN (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:STEPHEN
Last Name:DUNWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249
Mailing Address - Country:US
Mailing Address - Phone:209-754-3864
Mailing Address - Fax:209-754-5579
Practice Address - Street 1:372 LUDDY LANE
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-754-3864
Practice Address - Fax:209-754-5579
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice